title: Early loss of bone mineral density is correlated with a gain of fat mass in patients starting a protease inhibitor containing regimen: the prospective Lipotrip study.
abstract: BACKGROUND
  HIV-infected patients starting antiretroviral treatment (ART) experience deep and early disorders in fat and bone metabolism, leading to concomitant changes in fat mass and bone mineral density.
  
  
  METHODS
  We conducted a prospective study in treatment-naive HIV-infected patients randomized to receive two nucleoside reverse transcriptase inhibitors in combination with either a protease inhibitor (PI) or a non-nucleosidic reverse transcriptase inhibitor (NNRTI), to evaluate early changes in body composition, bone mineral density and metabolic markers as differentially induced by antiretroviral therapies. We measured changes in markers of carbohydrate, of fat and bone metabolism, and, using dual-emission X-ray absorptiometry (DXA), body composition and bone mineral density (BMD). Complete data on changes between baseline and after 21 months treatment were available for 35 patients (16 in the PI group and 19 in the NNRTI group).
  
  
  RESULTS
  A significant gain in BMI and in total and lower limb fat mass was recorded only in patients receiving PI. A loss of lumbar BMD was observed in both groups, being higher with PI. Plasma markers of bone metabolism (alkaline phosphatase, osteocalcin, collagen crosslaps) and levels of parathormone and of 1,25diOH-vitamin D3 significantly increased in both groups, concomitant with a decline in 25OH-vitamin D3. Lipids and glucose levels increased in both groups but rise in triglyceride was more pronounced with PI. A correlation between loss of BMD and gain of fat mass is observed in patients starting PI.
  
  
  CONCLUSIONS
  We evidenced an early effect of ART on lipid and bone metabolisms. PI lead to a significant gain in fat mass correlated with a sharp drop in BMD but active bone remodelling is evident with all antiretroviral treatments, associated with low vitamin D levels and hyperparathyroidism. In parallel, signs of metabolic restoration are evident. However, early increases in lean and fat mass, triglycerides, waist circumference and leptin are much more pronounced with PI.
authors.forename: Eric
authors.initials: E
authors.lastname: Bonnet
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Ruidavets
authors.forename: Anne
authors.initials: A
authors.lastname: Genoux
authors.forename: Laurence
authors.initials: L
authors.lastname: Mabile
authors.forename: Florian
authors.initials: F
authors.lastname: Busato
authors.forename: Martine
authors.initials: M
authors.lastname: Obadia
authors.forename: François
authors.initials: F
authors.lastname: Prévoteau
authors.forename: Bruno
authors.initials: B
authors.lastname: Marchou
authors.forename: Patrice
authors.initials: P
authors.lastname: Massip
authors.forename: Fabrice
authors.initials: F
authors.lastname: Marion-Latard
authors.forename: Cyrille
authors.initials: C
authors.lastname: Delpierre
authors.forename: Jacques
authors.initials: J
authors.lastname: Bernard
authors.forename: Bertrand
authors.initials: B
authors.lastname: Perret
mesh_terms: D000328:Adult; D000469:Alkaline Phosphatase / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D001823:Body Composition / Q000187:drug effects*; D015519:Bone Density / Q000187:drug effects*; D003094:Collagen / Q000097:blood; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000097:blood; D006801:Humans; D008297:Male; D010446:Peptide Fragments / Q000097:blood; D011446:Prospective Studies; D011480:Protease Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D018894:Reverse Transcriptase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D014807:Vitamin D / Q000097:blood
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011480:Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; C110762:glutamyl-lysyl-alanyl-histidyl-aspartyl-glycyl-glycyl-arginine; D014807:Vitamin D; D003094:Collagen; D000469:Alkaline Phosphatase